In Nigeria, where recent estimates show that only 45% of children living with HIV have been diagnosed and linked to treatment, a paediatric intensive case-finding approach was piloted in nine urban hospitals, with the aim to identify the most efficient facility-based HIV testing strategies for infants and children.
In this approach, potential points of service for paediatric HIV testing included the paediatric outpatient department (POPD), tuberculosis (TB) clinics, immunization clinics, inpatient paediatric wards and family index testing. The Bandason screening tool was used to determine eligibility for testing in the POPD, while in the immunisation clinics, a targeted approach offered HIV testing only to infants of mothers with diagnosed HIV or uncertain HIV status. All children with unknown HIV status at other entry points were eligible for testing. Awareness raising about the pilot project was conducted with relevant facility leadership and clinical staff.
Children younger than 18 months were tested with HIV DNA PCR, while a rapid diagnostic test was used for those over 18 months of age. Children who were newly diagnosed with HIV were immediately accompanied to the ART clinic by volunteer staff for ART initiation.
Impact: Over a five-month period, 2180 children with unknown HIV status were seen across the targeted facility entry points, where 1822 (83.6%) were tested, leading to a new HIV diagnosis for 43 children (2.4%). All were linked to care and initiated ART. Most children were tested through the POPD (49.7%) and family index testing (38%). The highest odds ratios of identifying an undiagnosed infant or child were in the TB clinic, paediatric inpatient wards and through family index testing
Orientation of facility staff
POPD – Brandason screening tool and test offer
Immunization clinic – offer if mother HIV positive/unknown status
Inpatient/TB services – offer to all status unknown
Family index testing – identification and offer to all HIV positive patients within ART clinics, ante-natal clinics, post-natal clinics and newly diagnosed in OPD with children status unknown
At entry into specific service – waiting room/bedside or during clinical consultation
POPD – waiting room
All other entry points – during one-on-one consultations
Facility entry point staff
DNA PCR or rapid HIV test
During routine paediatric out- or inpatient care
POPD, TB clinic, immunization clinic, paediatric inpatient ward
Nurse or clinician
Accompanied referral to ART clinic
Immediately following reactive result
From testing entry point to ART clinic